Contact details are available at the end of this leaflet. If after reading it, you have any concerns or require further explanation, please do not hesitate to contact the fracture clinic team. We understand you may not have seen a clinician face to face in fracture clinic however, most of your questions should be answered by this leaflet. This leaflet has been produced to give you general information about your injury. Need some help choosing a language? Please refer to Browsealoud Supported Voices and Languages. In addition, there may be pitting of the nails (very small groups of indentations) as well.You can translate this page by using the headphones button (bottom left) and then select the globe to change the language of the page. Patients usually have clinical manifestations of psoriasis-salmon-colored plaques with silver reticuli over the knees, elbows, lower back, and gluteal regions. Psoriasis may also lead to an oligoarthritis that affects the wrist. Moreover, a prior history of gouty attacks, which usually affect the great toe, knee, or ankle, may indicate this diagnosis. Most patients have signs of acute inflammation characterized by marked acute swelling, redness, warmth, and tenderness. Gout may present as an oligoarthropathy affecting the wrist. Rheumatoid arthritis usually has a bilateral distribution, and other joints such as the knee, metacarpals, and proximal interphalangeal joints may be affected. Flare-ups consist of signs of recurrent acute inflammation, including pain, redness, swelling, tenderness, and warmth. The presence of bilateral acute wrist pain or recurrent wrist pain is more likely secondary to a rheumatoid arthritis. Other conditions may cause arthritis of the wrist. Other carpal fractures or dislocations may also cause long-term instability and a degenerative arthritis. Patients present with unilateral involvement and complaints of joint pain stiffness, with decreased range of motion pain with activities such as lifting or gripping and hypertrophy. Long-standing cases of AVN of the scaphoid may result in a degenerative arthritis of the wrist this complication is caused by longstanding carpal instability. In addition, a poor blood supply, as occurs in diseases such as diabetes, may increase the risk. Acute AVN is more likely to follow a displaced scaphoid fracture greater than 1 mm, usually at the middle (waist), or an acute fracture involving the proximal pole. The proximal segment is most susceptible to damage because of the retrograde vascular supply, making the proximal vascularity the most tenuous. The middle one-third, the most frequent fracture site, is associated with a moderate risk of AVN, and fracture in the distal one-third rarely leads to AVN. The proximal one-third has the highest incidence of AVN. The risk of AVN depends on the location of the fracture. Much less common is an idiopathic osteonecrosis of the scaphoid. Trauma leading to displaced scaphoid fractures is the most likely cause of AVN. The scaphoid is the most frequently fractured wrist bone (see Chapter 38, “Scaphoid Fractures”), and AVN is the most common complication of a scaphoid fracture, occurring in 15% to 30% of cases. This can result in tiny breaks in the bone and the bone’s eventual collapse. There may be poor retrograde blood flow from the distal to the proximal scaphoid. Many patients with long-standing degenerative arthritis of the wrist may have had chronic instability from a preexisting wrist injury (i.e., unstable fracture or ligament tear) several years earlier.Īvascular necrosis (AVN) is the death of bone tissue due to a lack of blood.Lack of blood to the scaphoid may lead to arthritis.A poor blood supply may be associated with a higher risk of AVN.
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